engleski

Genital HPV Infection: Health Implication and Diagnosis

Genital papillomaviruses (HPV) infections are among the most common viral sexually transmitted infections. Approximately 40 HPV types infect the anogenital tract and a few types are consistently found in anogenital cancer biopsy specimens, notably cervical cancer. HPV DNA has been identified in almost all-cervical cancer biopsies, among which HPV type 16 is found in more than 50% of cervical cancer cases worldwide. HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82 are considered viruses with high oncogenic potential (high risk – HR), while HPV types 26, 53 and 66 are probably oncogenic. In contrast to HR HPV, HPV types 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81 and CP6108 are considered viruses with low oncogenic potential (low risk – LR). The high prevalence of latent HPV infection among sexually active young women and its significant decrease by 30 years of age reflects the transient nature of most cases of HPV infection. In contrast, persistent HPV infection over many years leads to genetic alterations, development of precancerous lesions and progression of those to cervical cancer. Thus, persistent HPV infection appears to play a central role in the pathogenesis of cervical cancer. As cervical pathogenesis develops slowly over many years cervical cancer could be prevented and treated if detected on time. Therefore, HPV detection and typing represents a useful and important tool for the diagnosis of HPV associated diseases and management of women at risk. The molecular methods used for HPV testing are based on the method of hybridization, DNA amplification or both. Several commercially methods suitable for large scale HPV testing in clinical laboratories are available. HPV testing detects prevalent infection and when applied at age 30 years or older, identifies those with a persistent type-specific infection. These women are at high risk for either having or developing cervical precancerous lesions. Recent clinical studies indicate that the combination of cervical cytology and HPV testing can significantly improve primary cervical cancer screening with a sensitivity of 100% for detecting cervical precancerous lesions. The very high negative predictive value of HPV testing allows longer screening interval. Furthermore, HPV test alone is significantly more sensitive than and as specific as conventional cervical cytology in a primary cervical cancer screening. HPV testing alone may also be an attractive alternative to cytology in low resource countries with a high prevalence of cervical cancer. Identification of cervical precancerous lesions through cervical cytology and/or HPV testing and eventually their prevention through HPV vaccination and public health measures will lead to a significant decrease, if not complete eradication of cervical cancer in the next decades.

Human papillomavirus (HPV)

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